Barshtein Gregory, Pries Axel R, Goldschmidt Neta, Zukerman Ayelet, Orbach Ariel, Zelig Orly, Arbell Dan, Yedgar Saul
Department of Biochemistry, Hebrew University Faculty of Medicine, Jerusalem, Israel.
Charité-Universitätsmedizin Berlin, Berlin, Germany.
Microcirculation. 2016 Oct;23(7):479-486. doi: 10.1111/micc.12296.
There is a growing concern regarding the risks in the transfusion of PRBC, as numerous studies have reported negative transfusion outcomes, including reduced blood perfusion. In search of this phenomenon's mechanism, the effect of PRBC deformability, a major determinant of blood flow, on transfusion outcome was explored.
The effect of PRBC deformability was examined by the transfusion-induced change in recipients' ∆SBF, in β-TM patients, who are routinely treated with lifelong frequent transfusions. SBF was determined using a laser Doppler imager.
∆SBF was examined vs PRBC deformability, the transfusion-induced increase in ∆Hct and the recipients' SBF before transfusion (SBF ). ∆SBF elevated with increasing PRBC deformability, with a highly significant dependence, while its elevation with ∆Hct was much less significant. ∆SBF was inversely proportional to the SBF .
This study provides, for the first time in humans, direct evidence that the deformability of transfused PRBC is a potent effector of transfusion outcome. Currently, PRBC are supplied primarily by the first-in-first-out criteria, while their functionality is ignored. The testing of PRBC hemodynamic quality would introduce a new paradigm into blood banking, which would contribute substantially to improving transfusion therapy.
由于众多研究报告了包括血液灌注减少在内的不良输血结果，人们对输注浓缩红细胞（PRBC）的风险越来越关注。为探究这一现象的机制，本研究探讨了作为血流主要决定因素的PRBC可变形性对输血结果的影响。
在常规接受终身频繁输血治疗的β-地中海贫血（β-TM）患者中，通过输血引起的受者ΔSBF变化来检测PRBC可变形性的影响。使用激光多普勒成像仪测定SBF。
将ΔSBF与PRBC可变形性、输血引起的ΔHct增加以及输血前受者的SBF（SBF₀）进行比较。ΔSBF随着PRBC可变形性的增加而升高，具有高度显著的相关性，而其随ΔHct的升高则不太显著。ΔSBF与SBF₀成反比。
本研究首次在人体中提供了直接证据，表明输注的PRBC可变形性是输血结果的一个重要影响因素。目前，PRBC主要按照先进先出的标准供应，而其功能被忽视。对PRBC血液动力学质量的检测将为血库引入一种新的模式，这将极大地有助于改善输血治疗。
